Mechanical Ventilation Complication Clinical Trial
Official title:
The Validity of Maximal Diaphragm Thickening Fraction to Measure Diaphragm Function in Mechanically Ventilated Patients
This study is designed to determine whether maximal diaphragm thickening fraction measured by ultrasound during volitional maximal inspiratory efforts is a valid measure of diaphragm function in mechanically ventilated patients.
Classically, assessing diaphragm function requires direct measurements of transdaphragmatic
pressure generation. A critical requirement for valid measurements is a maximal volitional
patient effort. An alternative is to standardize the stimulus to the diaphragm using magnetic
twitch stimulation fo the phrenic nerve. This is the gold standard technique for diaphragm
function measurement in the respiratory physiology laboratory.
Twitch measurements require technical expertise and expensive equipment; this technique is
therefore basically limited to the laboratory. Bedside ultrasonography has been proposed as a
method for measuring diaphragm function by assessing the thickening of the muscle during a
maximal inspiratory effort. In order to achieve a maximal volitional effort in mechanically
ventilated patients, several methods may be employed: coached maximal efforts, coached
sniffing, and transient airway occlusion to stimulate respiratory drive (Marini maneuver).
The investigators are evaluating the validity of diaphragm functional assessment using
bedside ultrasound in combination with coached efforts/sniffing/Marini maneuver against the
gold standard technique: twitch transdiaphragmatic pressure.
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